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NAME AS ON CARD: _____________________________________________
PHONE:___________________
CARD #:_____________________________________ EXP.___________ CCID#________
CITY:___________________________________ STATE:_______________ ZIP:________________
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authorize the charges to my card. ____________________________________________
USE YOUR MC - VISA - AMEX **SPECIAL
DISCOUNTS ON ALL DIRECT PHONE ORDERS** Waverly International - 82-04 101 AVE - Ozone Park, NY 11416 Tel:718.930.8188
- Fax:718.835.9248 - To Order: 888. 847. 2711 or 800-658-1747 www.waverlyint.com or www.recklessbydesign.com
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